Provider Demographics
NPI:1679931273
Name:FOUNDATION PSYCHOTHERAPY AND COUNSELING, LLC
Entity Type:Organization
Organization Name:FOUNDATION PSYCHOTHERAPY AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-254-3972
Mailing Address - Street 1:6123 WHITE MARBLE CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1658
Mailing Address - Country:US
Mailing Address - Phone:301-254-3972
Mailing Address - Fax:
Practice Address - Street 1:2919 OLNEY SANDY SPRING RD STE A
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1587
Practice Address - Country:US
Practice Address - Phone:301-254-3972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty